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Sub-maximal cardiopulmonary exercise test in Heart Failure: Which parameters should we trust?
Session:
Posters 2 - Écran 06 - IC Outros/Terapêutica
Speaker:
António Valentim Gonçalves
Congress:
CPC 2018
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.3 Chronic Heart Failure – Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
António Valentim Gonçalves; Rui M. Soares; Tiago Pereira Da Silva; Joana Gomes Feliciano; Pedro Rio; Ana Abreu; Rita Ilhão Moreira; Sílvia Aguiar Rosa; Tiago Mendonça; Madalena Coutinho Cruz; Dra. Inês Rodrigues; Luís Almeida Morais; Pedro Modas Daniel; João Pedro Reis; Tânia Branco Mano; Rui Cruz Ferreira
Abstract
<p><strong>Aims:</strong></p> <p>Peak oxygen consumption (pVO<sub>2</sub>) is a major criterion for listing patients for heart transplantation but requires a maximal cardiopulmonary exercise test (CPET). In the event of a sub-maximal CPET (respiratory exchange ratio (RER) < 1.05), a ventilation equivalent of carbon dioxide (V<sub>E</sub>/V<sub>CO2</sub>) slope may be considered for risk stratification according to current guidelines, despite a low level of evidence. </p> <p>We aimed to evaluate the power of different CPET parameters to predict adverse events in patients achieving maximal and sub-maximal CPETs.</p> <p> </p> <p><strong>Methods:</strong></p> <p>Ambulatory patients followed in our institution in NYHA class II-III and with left ventricular ejection fraction ≤40%, underwent a prospective evaluation including a CPET. All patients were followed for 60 months and the combined endpoint was cardiac death, urgent heart transplantation or need for mechanical circulatory support.</p> <p>The pVO<sub>2, </sub>pVO<sub>2 </sub>(%) predicted, V<sub>E</sub>/V<sub>CO2 </sub>slope, oxygen uptake efficiency slope (OUES) and heart rate recovery in the first minute (HHR1) were analyzed as potential predictors of the combined endpoint (Cox regression) and their predictive power was compared (area under the curve (AUC) analysis), in the subgroups of patients with achievement of RER ≥1.05 or <1.05 (Hanley & McNeil test for comparison of AUCs).</p> <p> </p> <p><strong>Results:</strong></p> <p>In the 274 enrolled patients, 98 achieved a RER <1.05 and 176 a RER ≥1.05; the combined event rates were 27,6% and 35,8%, respectively (p=0.164).</p> <p>Age (56.24±11,56 vs 52.14±12,13; p=0.007) and body mass index (p=0.003) were higher and diabetes mellitus (p=0.01) and cardiac resynchronization therapy (p=0.008) were more common in the RER < 1,05 group.</p> <p>The discriminative power of each CPET parameter is presented in the Table. The V<sub>E</sub>/V<sub>CO2 </sub>slope was the most accurate parameter for risk stratification in both RER <1.05 and ≥1.05 groups. No significant differences were found in the predictive power of pVO<sub>2</sub>, pVO<sub>2 </sub>(%) predicted or V<sub>E</sub>/V<sub>CO2 </sub>slope in sub-maximal versus maximal CPET, despite a numerically lower AUC in the RER <1.05 group. The HHR1 and OUES significantly lost discriminative power in the submaximal CPET group.</p> <p> </p> <p><strong>Conclusions:</strong></p> <p>V<sub>E</sub>/V<sub>CO2 </sub>slope seems to provide a discriminative power at least as good as pVO<sub>2</sub> for predicting adverse events in both submaximal and maximal CPET and more relevance should be given to V<sub>E</sub>/V<sub>CO2 </sub>slope in the assessment of candidates to heart transplantation.</p> <p>The discriminative power of HHR1 and OUES was lower in submaximal compared to maximal CPET.</p> <p> </p>
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